Monday, June 18, 2012

Case of the Week 212

The following was received in clinical parasitology for identification. The patient (a physician) was concerned because he found this arthropod attached to his thigh and wants to know what he should do. It was attached for approximately 6 hours. After removing it, he put it in the first container he could find (hence the interesting submission container!)

9 comments:

This is an Ixodes tick. If this is in the US the main thing of conern is Lyme disese. If he is in an endmic area a single dose of doxycycline might be warrented, although the risk of infection goes up with longer tick attachment.Bill M.

Ixodes tick, for the lyme disese he does not need antibotics or a screen. Borrelia are transmitted by leeching more than 24 hours. When he visited europe or asia, than he need a vaccination against FSME, RSSE or TBE.

It's a lovely, but unengorged Ixodes. 'Watchful waiting' is probably the best response except in hyperendemic areas -- and even there, given the unengorged nature of the creature. His risk of Lyme at least is low with a short attachment time. If he develops rash at the site, or fever, then treatment, without Lyme testing (which is insenstivie in early disease) is indicated; possibly with testing for Anaplasma or Babasia.

BTW: A rash is not 'compulsory' for a Lyme disease infection. I have Late Lyme and never had the famous rash. My advice would be to go to LLMD and not take any chances. Lyme disease and it's coinfections are disastrous.

Hello from the epicenter of Lyme disease in northeast CT. We do administer stat dose of doxy 200 mg and counsel about watching for signs and symptoms of Lyme, but also anaplasma and babesia, which are increasingly prevalent. These latter two, as well as TBE in Europe, can be transmitted within the first hours of feeding.

Deer tick, female, Ixodes scapularis.Flat-no sign of being on long enough to draw a lot of blood lowers the risk of disease transmission if the tick is infected with Lyme disease or Human granulocytic ehrlichiosis or Babesia microti but doesn't rule it out. Doxycycline-antibiotic.

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